| NPI | 1043641681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401015381) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 171M00000X Case Manager/Care Coordinator (Licence: MI 6401015381) | |
| Enumeration Date | 2013-12-09 |
| Last Update Date | 2019-11-19 |